[Lymph node metastases in the thoraco-cervical transitional region in thoracic esophageal cancer--with ultrasonic detection and a comment on the guide lines].

Lymph node metastases in the thoraco-cervical transitional region (TCTR) and its ultrasonic detection were evaluated in 64 patients with thoracic esophageal cancer, who received radical esophagectomy with modified neck dissection. Lymph node metastases in TCTR were found in 19 of 64 cases (29.7%). Nodal metastases in the supraclavicular region were found in similar incidence of 23.4% (15 of 64 cases). Lymph nodes in both regions were infiltrated in 8 cases. Direct metastases to supraclavicular region and metastases in single region of TCTR were indicated in 4 cases equally. The degree of lymph node metastases of 11 patients suffered from middle intra-thoracic esophageal (Im) cancer with nodal involvement in TCTR were divided into three groups, two cases of n2, one of n3 and eight of n4, according to the Guide Lines. Convex type probe excelled in description of TCTR. Swollen lymph nodes were detected in 12 out of 19 cases with metastases by preoperative ultrasound using this probe (sensitivity of 63.2%). Forty-four of 45 cases without metastases were diagnosed as such (specificity of 97.8%). The partition of TCTR in the Guide Lines should be reconsidered for better evaluation of the results on lymph node metastases in this region.